Veteran Housing Interest Form
For Veterans seeking stable, program-supported housing options
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Are you a U.S. veteran?
*
Yes
No
Branch of Service
*
Please Select
Army
Navy
Air Force
Marine Corps
Coast Guard
Space Force
Other
Do you have proof of veteran status (DD214, VA card, etc.)?
*
Yes (Required to submit before moving in)
No
Are you currently employed?
*
Yes (Full-Time)
Yes (Part-Time)
No (Receiving benefits/pension)
No (Unemployed)
Employer Name
*
Job Title (if applicable)
*
Monthly Income (USD)
*
Do you receive disability or VA benefits?
*
Yes
No
Do you have the ability to pay rent weekly?
*
Yes
No
Previous Landlord Name & Contact Information
*
Reason for Leaving Previous Residence
*
Have you ever been evicted?
*
Yes
No
If yes, please explain the circumstances.
Which room type are you interested in?
*
Premium Room (Queen Bed) with Half Bathroom - $250/week
Standard Room (Full Bed) - $200/week
Economy Room (Twin Bed) - $175/week
No preference
Personal Reference #1 (Name, Relationship, Phone Number)
*
Personal Reference #2 (Name, Relationship, Phone Number)
*
Emergency Contact (Name, Relationship, Phone Number)
*
Upload Proof of Income (recent paycheck stubs or proof of benefits)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload a copy of your Driver’s License or State ID (for identity verification)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload your Proof of Veteran Status (DD214, VA card, or Military ID)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Rental History Verification (letter from previous landlord or lease agreement, if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Do you agree to the house rules outlined in the description?
Yes, I understand and agree.
I confirm that all information provided in this application is accurate.
Yes, I certify the accuracy of my responses.
Do you have any special considerations or accommodations we should be aware of?
*
Any additional comments or questions?
*
Submit Application
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